One of our main projects aims to reduce the number of oral cancer deaths caused by chewing betel-nut in India. We have developed an innovative app, BICRAA (Betel nut Induced mouth Cancer Research & Awareness Application; www.bicraa.org), which promotes awareness of the risks of chewing betel nut and informs users of the signs of mouth cancer.
Betel nut has a long history in South and Southeast Asia and the Pacific Basin. In Guam and other Pacific islands, its use can be traced back as far as 2,000 years. A habit passed down through generations, chewing betel nut is a time-honoured custom for 10–20 percent of the world’s population. Today, the World Health Organization (WHO) estimates that around 600 million people use some form of betel nut. It is one of the most popular psychoactive substances in the world, in fourth place after nicotine, alcohol, and caffeine. But while betel nut is an important cultural and social tradition in many countries, growing evidence points to serious health effects from regular use, including cancer of the oral cavity (cancer of the mouth).
Many people chew betel nut for the energy boost it produces. This is likely due to the nut’s natural alkaloids, which release adrenaline. It may also result in feelings of euphoria and well-being. Some traditional beliefs hold that it may offer relief for a range of ailments, from dry mouth to digestive problems. However, the drug has not been well tested in clinical trials, and evidence of any health benefits is limited. Importantly, betel nut was identified as a Group I carcinogen by the International Agency for Research on Cancer in 2004.
The BICRAA application is a unique mobile and desktop app that will enable us to save lives by reducing the number of people globally suffering and dying from mouth cancer caused by chewing betel nut.
We have three main strategies:
- We plan to increase society’s knowledge and awareness of the risks associated with chewing the betel nut and the signs and symptoms of mouth cancers. This will enable individuals to make informed choices to improve their health and wellbeing.
- The app allows both individuals and healthcare professionals to quickly assess someone’s current and future risk of betel nut induced mouth cancer with a survey. The results provide clear advice on their risk and how to reduce it.
- We are currently using the app to collect important data globally regarding the use of betel nut. This has never been done on this scale before. On completion, we will publish our results to share the information which can then be used by international communities to encourage governmental and non-governmental organisations to increase their efforts against betel nut induced mouth cancer. It will also enable us to effectively target our future work.
Moreover, AGA-ENT supports basic research into betel nut-induced oral cancer by the provision of grants. Current work is assessing the molecular profile of betel nut-induced oral carcinomas through targeted deep sequencing. An improved understanding of the genetic landscape of these tumours will enable us to better understand the molecular mechanisms of carcinogenesis as well as identify potential diagnostic biomarkers and therapeutic targets. Oral cancer mortality has remained at roughly 50% over the past several decades with minimal improvement largely due to a lack of detection strategies and the continued prevalence of substance use. Since most cases are diagnosed at a late stage, when treatment options are limited, it is imperative that research is conducted with the aim of improving early detection. Our molecular studies will greatly contribute to this goal; at present, notable potential biomarkers have already been identified and the development of cost-effective tests to detect these in clinical samples, such as saliva and blood, are underway.